Occupational therapy fails to aid functioning in Alzheimer's patients

Alzheimer's disease currently affect over 5 million American seniors. Given that the majority of dementia disorders cannot be cured, caregiving and support are highly significant. Most patients with Alzheimer's live with the illness at home and are cared for by members of their family. New research, however, suggests home-based occupational therapy may not be very effective in slowing down mental decline.

Research shows occupational therapy may be less effective than we think.

Alzheimer's disease is the sixth leading cause of death in the United States. It is currently estimated to affect 5.4 million Americans, or 1 in 9 adults aged 65 and over.

Given that Alzheimer's and most dementia-related conditions do not have a cure or a disease-modifying treatment, most patients live with the disease and are cared for in their home by a family member.

In fact, 70 percent of patients with Alzheimer's live at home, and they receive 75 percent of their care from an informal caregiver.

Over 15 million people in the U.S. work as unpaid caregivers, their efforts amounting to hundreds of billions of dollars each year.

Additionally, caregivers for people with dementia bear a heavier burden compared with other caregivers, as a quarter of them work at least 40 hours each week.

Most of the care provided involves assisting with daily activities, such as household chores, shopping, cooking, or providing transportation.

Helping patients do their day-to-day activities, with the aim of recovering physical or mental abilities and regaining a sense of independence, is commonly referred to as occupational therapy.

New research - published in the journal Annals of Internal Medicine - examines whether occupational therapy actually helps slow down cognitive and functional decline in patients with Alzheimer's.

Assessing the effect of occupational therapy on Alzheimer's patients

A team of researchers from the Indiana Center for Aging Research and the Regenstrief Institute in Indianapolis, IN, wanted to see if collaborative care combined with 2 years of home-based occupational therapy delays functional decline.

The team was led by Dr. Cristopher M. Callahan, the Cornelius and Yvonne Pettinga professor of medicine at Indiana University's School of Medicine, and the founding director of the Indiana University Center for Aging Research.

Participants were divided into two groups. All 180 participants received collaborative care for dementia from the Healthy Aging Brain Center, in collaboration with the primary care practices from the Eskenazi Health Center.

The researchers at Indiana University and the Regenstrief Institute had previously shown that their primary care practices reduced caregiver stress and improved behavioral symptoms for patients. However, their practices were not shown to stop functional decline.

In this new study, one of the two groups also received occupational therapy for 24 months, in addition to collaborative care. The intervention group had 91 participants.

Over the 2 years, an occupational therapist traveled to the home of the patient and family caregiver.

The occupational therapy was tailored to the needs of each patient and focused on issues identified by the caregiver, such as bathing safely or getting in and out of cars. Therapists also helped patients resume activities they used to enjoy before the disease, such as gardening.

Participants remained seated for the majority of the sessions.

At the end of the 24 months, researchers measured the ability to function in daily living for both groups.

Occupational therapy did not reduce functional decline

Both groups showed a similar decline in functional living scores, the researchers found.

"Persons with dementia face a steady decline in function that we found is not slowed by home-based occupational therapy," says Dr. Callahan.

The tailored therapy did not delay the loss of everyday functions, such as walking, eating, bathing, and toileting.

"The participants in the study declined both mentally and functionally as the neurodegeneration of the brain continued. This is a disappointing outcome because previously published, but shorter-term studies had suggested these interventions might be able to slow the physical decline that leads to nursing home placement."

Dr. Cristopher M. Callahan

Given the imminent and irreversible cognitive decline in dementia and the lack of drug-based therapies, treatment options are limited. As Dr. Callahan points out, this makes caregiving extremely important, as well as the decisions we make regarding our use of resources.

"There is a limited amount of money that we - families and society - have available for these patients and their caregivers and we should spend that money on things that patients and families find the most helpful," Dr. Callahan says. He also emphasizes the importance of making a wider range of options available to support family caregivers.

Dr. Callahan suggests that making home adjustments, such as removing risks for falls, making bathrooms more easily accessible, and making kitchens safer, may keep Alzheimer's patients out of an institution and help them enjoy the comfort of their home for longer.

As the authors of the study conclude:

"Given the burden of caring for persons with dementia, which largely is shouldered by family members, research must focus on identifying strategies to support caregivers in the home to provide care to persons with dementia.

If the gradual functional decline attributable to Alzheimer's disease is irreversible, a new generation of assistive devices, home modifications, community services, and technologies is needed to make longer-term support in the home a practical reality for patients and families."

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Comments(6)

This article provides a completely inaccurate portrayal of the role of Occupational Therapy in dementia care, and it provides a recklessly simplistic description of what Occupational Therapy is in general. In my experience with dementia care working in the field, the goal of OT intervention is never remediation or slowing the disease progression. There might be functional goals related to delaying a hospital admission, but those tend to be through ongoing functional assessment, home modification, equipment provision, falls risk prevention and behaviour management. OT intervention also works with people to enable them to participate in meaningful activity which can have an impact on quality of life. Quality of life measures have an incredible impact for people with terminal diseases like Alzheimer's and their families. In many sites Occupational Therapists are also the clinicians who conduct seating and mobility assessments for equipment and assess and treat pressure ulcers -- areas that are of utmost important to dementia care at home and in the hospital.

I really feel that this article does not provide an adequate representation of Occupational Therapy. Please consider posting something more factually comprehensive.

This online article written by journalist Ana Sandoiu is meant to relay the results of a study on the prevention of functional decline of people with Alzheimer disease. Ms. Sandoiu concluded that the results are that : “Occupational therapy did not reduce functional decline”.

This statement is not exact. The researchers stated that : “The results of this trial are indeterminate and do not rule out potentially important effects of the intervention.”

This is strikingly different.

A careful appraisal of the original research article allows us to understand that adding occupational therapy home-based services to an already well-implemented best-practice collaborative approach does not seem to prevent functional decline significantly.

Many questions remain. What is the effectiveness of this approach when occupational therapy home-based services are provided in a context where such best practice is not available? What would happen if these services are provided along with the proper home modifications, technological and community support?

Research is an evolutive process that requires the ability of weighting the different elements of proof before making general assertions. In this case, four (4) previous studies had reported positive and encouraging results for the occupational therapy home-based services. Do the results of one single study counteract all that was done previously? This is not evidence-based practices and this is not what the authors of this original work wrote.

We hope our comments will help to put perspective and advance our collective research of effective solutions.

The Canadian Association of Occupational Therapists (CAOT)

Note: We would be pleased to provide the full citations of research articles reporting the positive outcomes of occupational therapy services for people with Alzheimer or other types of dementia. Please contact us at practice@caot.ca

As an OT working in dementia care in the community, I would like to offer my support for Joshua's comments re: opinion on the article above. We do not strive to reduce the functional decline, unfortunately that is usually inevitable. Our focus is aiming to maximize quality of life for the client and their family/caregivers - ensuring safety, managing challenging behaviours, providing caregiver support and education, advocating for community supports.

I have been working in various nursing homes in the past 30+ yrs as a physical therapist. Government sets up this requirements for patients receiving free Med-A coverage in Nursing Home based on their having intensive therapy programs (P.T., O.T. & S.T.) are a total wasted of our tax-payers' money. 70% of those residents in nursing homes who received therapies had NO significant benefits/progresses after 20 days' 'rehab care'. The only beneficiaries are those of big therapy companies & nursing homes. They ripped off big money from Medicare under the false impression of providing good & constructive cares to our senior citizens. Many old residents in nursing homes did not need any therapy at all after 3 days' staying in hospital, but, rehab therapy became a 'must' in all our nursing homes now a day after any hospital staying. What a shame.

I see the purpose and results of your study, but the scope of occupational therapy includes more than slowing physical and cognitive declines in these patients. In the concluding, paragraph you actually better describe our scope of practice,

"Dr. Callahan suggests that making home adjustments, such as removing risks for falls, making bathrooms more easily accessible, and making kitchens safer, may keep Alzheimer's patients out of an institution and help them enjoy the comfort of their home for longer"

All of those recommendations are common practice for OT's working in home health. So your point is actually that Alzheimer's progresses regardless of either interventions and then you actually recommend home modification and assistive device management which are OT interventions.

Function in ADLs is one aspect of OT & not a measure of its worth in dementia care. OT is likely to improve quality of life, reduce the need for pharmacological intervention for challenging behaviour & support caters to manage dementia in a loved one. All of which can save time & money.

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